NPIMap

Individual provider Active NPI

Stephanie Ann Shibata, PA-C

  • Physician Assistant
  • Henderson, NV
National Provider Identifier
1366863953
Registry record updated May 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1480 Issued in NV
Practice address
825 N Gibson Rd Ste 311
Henderson, NV 89011-1708
Phone
(027) 768-3007
Fax
(702) 776-8408
NPI assigned
Dec 26, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1480 NV Primary

Addresses

Primary practice location

825 N Gibson Rd Ste 311
Henderson, NV 89011-1708

Mailing address

825 N Gibson Rd Ste 311
Henderson, NV 89011-1708
Phone (702) 776-8300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140219000362 NV Practitioner - Physician Assistant 4688803539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Infectious Diseases of Southern Nevada a Professional LLCGroup PAC ID 7012065576, 13 clinicians

Practice addresses (Care Compare)

825 N Gibson Rd
Suite 311
Henderson, NV 89011-1708
Phone (702) 776-8300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Health Past Accepting new patients
University Medical Center of Southern Nevada Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Apollocare Partners of Nevada, Inc. PastSince Jan 4, 2026 Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716768000000",
    "number": "1366863953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N GIBSON RD STE 311",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890111708",
            "telephone_number": "702-776-8300",
            "fax_number": "702-776-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N GIBSON RD STE 311",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890111708",
            "telephone_number": "027-768-3007",
            "fax_number": "702-776-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIBATA",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-12-26",
        "last_updated": "2024-05-27",
        "certification_date": "2024-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.